Higher efficacy of Etoposide + Cytarabine Plus Pegfilgrastim in poorly mobilizing Multiple Myeloma and lymphoma Patients

Abstract

Background aims: An optimal strategy for mobilizing hematopoietic stem cells in poorly mobilizing patients with multiple myeloma (MM) and lymphoma has not yet been determined.

Methods: We retrospectively analyzed the efficacy and safety of etoposide combined with cytarabine (etoposide 75 mg/m², daily d1∼2; Ara-C 300 mg/m², every 12 h d1∼2), plus pegfilgrastim (6 mg d6) in 32 patients with MM or lymphoma, among whom 53.1% were defined as "proven poor mobilizers."

Results: This approach resulted in adequate mobilization (≥2.0 × 10⁶ CD34⁺ cells/kg) in 93.8% of patients and optimal mobilization (≥5.0 × 10⁶ CD34⁺ cells/kg) in 71.9% of patients. A total of 100% of patients with MM reached at least 5 × 10⁶ CD34⁺ cells/kg collected, the amount required for double autologous stem cell transplant. In total, 88.2% of patients with lymphoma reached at least 2 × 10⁶ CD34⁺ cells/kg collected, the amount required for a single autologous stem cell transplant. This was achieved with a single leukapheresis in 78.1% of cases. A median peak number of 42.0/μL circulating CD34⁺ cells and a median number of blood CD34⁺ cells counts in 6.7 × 10⁶/L were collected among 30 successful mobilizers. Approximately 6.3% of patients required plerixafor rescue, which was successful. Nine (28.1%) of the 32 patients suffered grade 2∼3 infections, and 50% required platelet transfusions.

Conclusions: We conclude that chemo-mobilization with etoposide, Ara-C and pegfilgrastim in poorly mobilizing patients with MM or lymphoma is very effective and has acceptable toxicity.

Keywords: autologous stem cell transplant; cytarabine; etoposide; pegfilgrastim; poorly mobilizing.